Cancer care with value at the centre: a case study. Christobel Saunders Head of Surgery Medical School The University of Western Australia

WHAT IS THE PROBLEM? Number of cancer survivors in Australia Currently, over a million and expected to double by 2030. Our health systems Focus on minimising cost and limiting services. Patients rarely asked what are most valued outcomes for them. Is good value for patient=good value for system? Cost-efficient services do not necessarily deliver value for patients. Healthcare struggles to achieve value despite huge ICT investment we do not capture most outcomes that matter to patients Of the 1,958 measures in the US National Quality Measures Clearinghouse, only 7% measured outcomes and less than 15% of these came from the patients themselves. Source: Porter ME et al, Standardizing Patient Outcome Measurement. NEJM, 374, 504 506, 2016

WHAT IS THE SOLUTION? The core purpose of health care is value for patients Health outcomes that matter to patients Value = Costs of delivering those outcomes Delivering high value for patients must be the central goal of every health care organization - financial success is the result of delivering value, not the end in itself Health care delivery must shift from volume to value Copyright Michael Porter 2015

HOW DOES A PATIENT DEFINE HEALTH?

THE IMPORTANCE OF MEASURING MULTIPLE OUTCOMES PROSTATE CANCER CARE IN GERMANY Average hospital Best hospital 5 year disease specific survival 94% 95% Severe erectile dysfunction after one year 75.5% 17.4% Incontinence after one year 43.3% 9.2% Source: ICHOM Copyright Michael Porter 2016

WA Continuous Improvement Care - Cancer Project Population health & epidemiology Clinical research & PROMs Change management i.e. business research Data linkage & biostatistics CIC Cancer Team Health policy & economics Health informatics systems Health services & health outcomes

AIM : CAN WE EMBED VBHC INTO CANCER PRACTICE AND SO IMPROVE OUTCOMES? PHASE 1: ENGAGEMENT PHASE 2: DEVELOPMENT AND IDENTIFICATION OF DATA CAPTURING TOOLS PHASE 3: DATA EVALUATION PHASE 4: FEEDBACK, REVISE AND REVIEW

KEY ENABLER - ENGAGEMENT Clinical Leaders Consumers Hospital Management Service Providers Researchers SPECIALISED SITES/CANCERS

KEY ENABLER DATA Define universal clinical and patient-reported measures Establishing a data-capture model to routinely determine value of the care delivered Web-based, multi-level access, time stamped data, longitudinal data capture, interoperability with existing systems

ICHOM STANDARD SETS Colorectal Cancer Breast Cancer Lung Cancer Advanced Prostate Cancer Localised Prostate Cancer Source: ICHOM Copyright 2016 by the International Consortium for Health Outcomes Measurement. All rights reserved.

KEY ENABLER -FEEDBACK Source: BCBSM Michigan

CHALLENGES Engagement Getting services to provide e.g. data input Ethics/Consent/security Health economics Data Who extracts/inputs data? Data ownership, storage, Mx Flexibility across sites and workflows How to capture PROMs and what % is enough Proliferation of IT providers Feedback Outliers - not a witch hunt!

SCALING UP Measuring patient reported outcomes is part of the revolution called value based health care It has enormous potential to improve how we practice and how we benefit our patients Implementing it is not easy (or cheap) to begin with But we do now have standardised tools which can be customised It needs champions, buy-in, data solutions Feedback and embedding research and quality improvement are vital It is bigger than cancer Needs government and needs funding models to drive it